Evaluation of corneal biomechanical properties on ocular response analyzer and their correlation with the clinical profile of the patients with thyroid-associated ophthalmopathy.

Purpose: The study evaluates the corneal biomechanical properties on Ocular Response Analyzer (ORA) and aims to establish their correlation with the clinical profile of patients with TAO.Methods: A tertiary care centre-based cross-sectional observational study was conducted. Eighty patients with stage I and II TAO (EUGOGO classification), categorized as group A, were age and sex matched with 85 controls constituting group B. The disease activity was assessed using clinical activity score (CAS). The thyroid hormonal profile of within one-week duration was recorded for each patient of group A. Mean IOP-GAT (IOP using Goldmann applanation tonometer), IOPg (Goldmann-correlated IOP value), IOPcc (cornea-compensated IOP value), CRF (corneal resistance factor), and mean corneal hysteresis (CH) of group A and B were compared. The variation of CH with disease severity, activity, and thyroid status in group A was evaluated.Results: Mean GAT, IOPg, and IOPcc of group A were significantly higher than that of group B (p < .001). Mean CH of group A i.e the visco-elastic dampening ability of cornea was significantly lower than that of group B (p < .001). In group A, mean CH of patients with stage 1 disease severity and CAS<3 was significantly higher than that of patients with stage 2 severity and CAS≥3 (p < .001). CH of hyperthyroid patients was significantly lower than CH of hypothyroid patients (p < .01).Conclusion: TAO affects the biomechanical properties of the globe as reflected by the corneal biomechanics on ORA. The disease severity, activity, and hyperthyroid status are negatively correlated with the CH.

Short-term outcome of botulinum neurotoxin A injection with or without sodium hyaluronate in the treatment of infantile esotropia-a prospective interventional study.

Purpose: To compare the short-term outcome of botulinum neurotoxin A (BoNT-A) with or without sodium hyaluronate in the treatment of infantile esotropia (IE). Methods: In this tertiary care hospital-based prospective, interventional, non-randomized study on infants with IE below one year of age, 25 cases were enrolled in the sodium hyaluronate (SH) group to receive 2.5 U BoNT-A injection combined with SH in each medial rectus muscle (MR). Thirty patients were enrolled in the control group to receive 2.5 U BoNT-A injection with normal saline in each MR. The change in mean primary ocular deviation (POD) and complications were assessed at 2 weeks, 1 month, 3 months, and 6 months post injection. Mann-Whitney U test was used for non-parametric unpaired data. Chi-square test and Fisher's exact test were used to test for the strength of the association between the two categorical variables. Results: Satisfactory ocular alignment was achieved in 76% in SH group and 73% in the control group (P value = 0.80). While the change in mean POD was comparable (29.2 prism diopters [PD] vs 29.3 PD; P value = 0.65), the complication rates were significantly lesser in SH (16% vs 33.3%; P value = 0.14). Conclusion: BoNT-A combined with SH is equally effective with lesser complications as compared to botulinum toxin alone in the treatment of IE.

Teleconsultation at a tertiary care government medical university during COVID-19 Lockdown in India - A pilot study.

PURPOSE: COVID-19 related pan- India lockdown brought teleophthalmology to the forefront. The study ventures to understand the relevance of this modality in a government setup. The objective is to understand the feasibility, clinical profile and addressability of patients using teleconsultation in ophthalmology at a tertiary care government medical university during the COVID-19 Lockdown in India. METHODS: An online survey targeting faculty members and resident doctors in a tertiary eye center in a government medical university in north India was conducted. Various aspects of teleconsultation were analyzed including the number and preferential mode of consultations, commonest complaints and diagnoses made. Frequency and factors mandating physical examination of patients was also analyzed. RESULTS: The questionnaire was sent to 40 ophthalmologists of whom 38 responded. A total of 4880 teleconsultations were given. The commonest mode of communication was by WhatsApp messages (65.6%) and E-mail was the least preferred medium. More than 80% consultations were from previously seen patients. Red eye was the commonest presenting complaint (22.8%), followed by watering (18.7%) and foreign body sensation (14.5%). Computer vision syndrome was the commonest diagnosis (25.9%) followed by conjunctivitis (17.7%) and refractive error (17.7%). About 40% required physical examination, mostly due to uncertain diagnosis (22%) or inadequate response to prescribed treatment (19%). CONCLUSION: Teleconsultation was feasible in a government medical university for providing ophthalmic services during lockdown. WhatsApp was the preferred communication modality, computer vision syndrome was the most frequent tentative diagnosis and approximately 60% did not require in-person physical examination.